Medication Summary
The goal of pharmacotherapy for drug-induced photosensitivity is to reduce morbidity and to prevent complications. Broad-spectrum sunscreens with coverage in the UV-A and UV-B ranges are recommended. Sunscreens containing avobenzone (Parsol 1789) absorb light in the UV-A range. Physical sunscreen agents, such as titanium dioxide and zinc oxide, have full UV spectrum protection. Note that some individuals are allergic to some chemical sunscreens that are sensitizers and may induce contact dermatitis and/or photoallergy.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli. Potent class I and II topical steroids may be used. Less potent topical steroids such as hydrocortisone valerate, desonide, or fluticasone may be used twice a day in children to decrease risk of systemic absorption.
Clobetasol (Cormax, Temovate)
Clobetasol suppresses mitosis and increases the synthesis of proteins that decrease inflammation and cause vasoconstriction.
Betamethasone topical (Diprolene, Betatrex, Diprosone)
Betamethasone topical is used for the treatment of inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Hydrocortisone valerate (Westcort)
Hydrocortisone valerate is an adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. It has mineralocorticoid and glucocorticoid effects that result in anti-inflammatory activity.
Desonide (DesOwen, Tridesilon)
Desonide stimulates the synthesis of enzymes that decrease inflammation. It suppresses mitotic activity and causes vasoconstriction.
Fluticasone (Cutivate)
Fluticasone has extremely potent vasoconstrictive and anti-inflammatory activity. It has a weak hypothalamic-pituitary adrenocortical axis inhibitory potency when applied topically.
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Phototoxic reaction.
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Photoallergic reaction.
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Pseudoporphyria.
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Subacute cutaneous lupus erythematosus exacerbated by terbinafine. Courtesy of Jeffrey P. Callen.
Tables
Class |
Medication |
Photo-toxic Reaction |
Photo-allergic Reaction |
Lichenoid Reaction |
Pseudo-porphyria |
Subacute Cutaneous Lupus Erythematosus |
Antibiotics |
Tetracyclines (doxycycline, tetracycline) |
Yes |
No |
Yes |
Yes |
No |
Fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) [10] |
Yes |
No |
No |
No |
No |
|
Sulfonamides |
Yes |
No |
No |
No |
No |
|
Nonsteroidal anti-inflammatory drugs [11] |
Ibuprofen |
Yes |
No |
Yes |
No |
No |
Ketoprofen [12] |
Yes |
Yes |
No |
No |
No |
|
Naproxen [13] |
Yes |
No |
Yes |
Yes |
No |
|
Celecoxib [14] |
No |
Yes |
No |
Yes |
No |
|
Diuretics |
Furosemide |
Yes |
No |
No |
Yes |
No |
Bumetanide |
No |
No |
No |
Yes |
No |
|
Hydro-chlorothiazide |
Yes |
No |
No |
No |
Yes |
|
Retinoid |
Isotretinoin |
Yes |
No |
No |
No |
No |
Acitretin |
Yes |
No |
No |
No |
No |
|
Hypoglycemics |
Sulfonylureas (glipizide, glyburide) [10] |
No |
Yes |
Yes |
Yes |
No |
HMG-CoA* reductase inhibitors |
Statins (atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin) [15] |
Yes |
Yes |
Yes |
Yes |
No |
Epidermal growth factor receptor inhibitors |
Cetuximab, panitumumab, erlotinib, gefitinib, lapatinib, vandetanib [16] |
Yes |
Yes |
Yes |
Yes |
No |
| BRAF inhibitors | Vemurafenib, [6, 7, 8, 17] sorafenib | Yes | No | No | No | Yes |
Photodynamic therapy prophoto-sensitizers |
5-Aminolevulinic acid [18] |
Yes |
No |
No |
No |
No |
Methyl-5-aminolevulinic acid |
Yes |
No |
No |
No |
No |
|
Verteporfin [19] |
Yes |
No |
No |
No |
No |
|
Photofrin [20] |
Yes |
No |
No |
No |
No |
|
Neuroleptic drugs [21] |
Phenothiazines (chlorpromazine, fluphenazine, perazine, perphenazine, thioridazine) [22] |
Yes |
Yes |
Yes |
No |
No |
Thioxanthenes (chlorprothixene, thiothixene) |
Yes |
No |
No |
No |
No |
|
Antifungals |
Terbinafine |
No |
No |
No |
No |
Yes |
Itraconazole |
Yes |
Yes |
No |
No |
No |
|
Yes |
No |
No |
Yes |
No |
||
Griseofulvin |
Yes |
Yes |
No |
No |
Yes |
|
Other drugs |
Para-aminobenzoic acid |
Yes |
Yes |
No |
No |
No |
5-Fluorouracil |
Yes |
Yes |
Yes |
Yes |
No |
|
Yes |
No |
No |
No |
Yes |
||
Amiodarone |
Yes |
No |
No |
Yes |
No |
|
Diltiazem |
Yes |
No |
No |
No |
Yes |
|
Quinidine |
Yes |
Yes |
Yes |
No |
No |
|
Hydroxychloroquine |
No |
No |
Yes |
No |
No |
|
Coal tar |
Yes |
No |
No |
No |
No |
|
Enalapril |
No |
No |
No |
No |
Yes |
|
Dapsone |
No |
Yes |
Yes |
Yes |
No |
|
No |
Yes |
No |
Yes |
No |
||
Sunscreens [30] |
Para-aminobenzoic acid |
No |
Yes |
No |
No |
No |
Cinnamates |
No |
Yes |
No |
No |
No |
|
Benzophenones |
No |
Yes |
No |
No |
No |
|
Salicylates |
No |
Yes |
No |
No |
No |
|
Fragrances |
Musk ambrette |
No |
Yes |
No |
No |
No |
6-Methylcoumarin |
No |
Yes |
No |
No |
No |
|
*3-Hydroxy-3-methylglutaryl coenzyme A. |
||||||
Feature |
Phototoxic Reaction |
Photoallergic Reaction |
Incidence |
High |
Low |
Amount of agent required for photosensitivity |
Large |
Small |
Onset of reaction after exposure to agent and light |
Minutes to hours |
24-72 hours |
More than one exposure to agent required |
No |
Yes |
Distribution |
Sun-exposed skin only |
Sun-exposed skin, may spread to unexposed areas |
Clinical characteristics |
Exaggerated sunburn |
Dermatitis |
Immunologically mediated |
No |
Yes; Type IV |
